Dexamethasone for the prevention of postoperative nausea and vomiting:: A quantitative systematic review
Dexamethasone for the prevention of postoperative nausea and vomiting:: A quantitative systematic review
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DOI：
10.1097/00000539-200001000-00038
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发表时间：
2000-01-01
影响因子：
5.7
通讯作者：
Tramèr, MR
中科院分区：
文献类型：
--
作者：
Henzi, I;Walder, B;Tramèr, MR
地塞米松在预防术后恶心呕吐（PONV）中的作用尚不清楚。我们回顾了地塞米松预防 PONV 的有效性和安全性数据。我们进行了系统检索（MEDLINE、EMBASE、Cochrane 图书馆、手工检索、参考书目、所有语言，截至 1999 年 4 月），以获得手术患者中地塞米松与其他止吐药或安慰剂随机比较的完整报告。相关终点包括预防早期 PONV（术后 0 至 6 小时）、晚期 PONV（0 至 24 小时）和不良反应。分析了来自 17 项试验的 1,946 名患者的数据：598 名患者接受了地塞米松治疗； 582 人接受了昂丹司琼、格拉司琼、氟哌利多、甲氧氯普胺或奋乃静治疗； 423 人接受了安慰剂； 343 名患者接受了地塞米松与昂丹司琼或格拉司琼的联合治疗。使用安慰剂时，早期和晚期 PONV 的发生率分别为 35% 和 50%。测试了 16 种不同的地塞米松方案，最常见的是成人 8 或 10 mg IV，儿童 1 或 1.5 mg/kg IV。在这些剂量下，与安慰剂相比，成人和儿童预防早期和晚期呕吐所需治疗的人数分别为 7.1（95% CI 4.5 至 18）和 3.8（2.9 至 5）。在成人中，预防晚期恶心所需治疗的人数为 4.3（2.3 至 26）。地塞米松联合昂丹司琼或格拉司琼进一步降低 PONV 风险；与单独使用5-HT3受体拮抗剂相比，联合治疗方案预防晚期恶心和呕吐所需治疗的人数分别为7.7（4.8至19）和7.8（4.1至66）。缺乏与其他止吐药比较的数据来得出合理的结论。没有关于地塞米松相关不良反应的报道。意义：当术后恶心和呕吐的风险较高时，与安慰剂相比，单次预防性剂量的地塞米松具有止吐作用，且没有证据表明对其他健康患者有任何临床相关毒性。晚期疗效似乎最为明显。目前可用的术后恶心和呕吐的最佳预防方法很可能是通过将地塞米松与 5-HT3 受体拮抗剂联合使用来实现。需要确定该组合的最佳剂量。
The role of dexamethasone in the prevention of postoperative nausea and vomiting (PONV) is unclear. We reviewed efficacy and safety data of dexamethasone for prevention of PONV. A systematic search (MEDLINE, EMBASE, Cochrane Library, hand searching,bibliographies, all languages, up to April 1999) was done for full reports of randomized comparisons of dexamethasone with other antiemetics or placebo in surgical patients. Relevant end points were prevention of early PONV (0 to 6 h postoperatively), late PONV (0 to 24 h), and adverse effects. Data from 1,946 patients from 17 trials were analyzed: 598 received dexamethasone; 582 received ondansetron, granisetron, droperidol, metoclopramide, or perphenazine; 423 received a placebo; and 343 received a combination of dexamethasone with ondansetron or granisetron. With placebo, the incidence of early and late PONV was 35% and 50%, respectively. Sixteen different regimens of dexamethasone were tested, most frequently, 8 or 10 mg IV in adults, and 1 or 1.5 mg/kg IV children. With these doses, the number needed to treat to prevent early and late vomiting compared with placebo in adults and children was 7.1 (95% CI 4.5 to 18), and 3.8 (2.9 to 5), respectively. In adults, the number needed to treat to prevent late nausea was 4.3 (2.3 to 26). The combination of dexamethasone with ondansetron or granisetron further decreased the risk of PONV; the number needed to treat to prevent late nausea and vomiting with the combined regimen compared with the 5-HT3 receptor antagonists alone was 7.7 (4.8 to 19) and 7.8 (4.1 to 66), respectively. There was a lack of data from comparisons with other antiemetics for sensible conclusions. There were no reports on dexamethasone-related adverse effects. Implications: When there is a high risk of postoperative nausea and vomiting, a single prophylactic dose of dexamethasone is antiemetic compared with placebo, without evidence of any clinically relevant toxicity in otherwise healthy patients. Late efficacy seems to be most pronounced. It is very likely that the best prophylaxis of postoperative nausea and vomiting currently available is achieved by combining dexamethasone with a 5-HT3 receptor antagonist. Optimal doses of this combination need to be identified.